Effect of the elderly and increasing injury severity on acute hospital resource utilization in a cohort of inner city trauma patients

ANZ J Surg. 2013 Jan;83(1-2):60-4. doi: 10.1111/j.1445-2197.2012.06177.x. Epub 2012 Aug 7.


Objective: This study aimed to determine the relative effect of elderly patients and increasing injury severity on acute hospital costs and inpatient length of stay.

Methods: A prospective study of all trauma team activations at a single inner city trauma centre was conducted over a 1-year period. Costs were imputed using Australian Refined Diagnosis-Related Groups. Costs and inpatient length of stays were compared between elderly (age ≥65 years) and non-elderly patients. Relative effects of increasing injury severity score (ISS) and age categories were modelled using generalized linear regression.

Results: Over the study period, 1096 consecutive patients were studied. Falls were the most common mechanism and contributed the highest proportion of aggregate costs. There was a moderately high correlation between cost and ISS (Spearman's rank correlation coefficient 0.65, P < 0.001). Median costs for elderly patients were around three times higher than that for non-elderly patients and median length of stay was over twice that of non-elderly patients (7 days versus 3 days, P < 0.001). After adjusting for injury severity, the predicted costs of elderly trauma patients were around 30% higher compared with non-elderly patients. An increasing effect of injury severity on cost was observed across minor and major trauma.

Conclusion: Both injury severity and elderly patients have a significant impact on acute hospital costs across the spectrum of major and minor trauma.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Health Resources / economics
  • Health Resources / statistics & numerical data*
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Injury Severity Score
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data*
  • Linear Models
  • Male
  • Middle Aged
  • New South Wales
  • Prospective Studies
  • Trauma Centers / economics*
  • Trauma Centers / statistics & numerical data
  • Urban Health Services / economics*
  • Urban Health Services / statistics & numerical data
  • Wounds and Injuries / economics
  • Wounds and Injuries / etiology
  • Wounds and Injuries / therapy*